HomeMy Public PortalAbout9454 OLEMA ST_Sewer__ DT PART3iENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS [
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS _ CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. CC
NEAREST -� � A I J
CROSS ST. - --
RECEIVED BY Ready for Inspection I DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE ( OCCUPANCY BK MAP PG
_
CITY TEL.NO. If
CONTRACTOM, C. Mi (itf.=se 4.'s31,
66. 10 jelitple �ltjCO.IMP.N0.
ADDRESS 543.3 N, CLOVERLT AV JOB.NO.
CITY TUAKE C*t.,t*llFg TRUNK PERMIT NO.
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE
BUILDIt NGS
CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 I RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO f
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
_
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER_
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ;1 1 00 Y CURB !'.L. M.L.To P.L.
AUTHORIZATION I TOTAL FEE I
HAVE ICONTRACTOIS DATE CONTRAED WITH THE R TO CONNECT TAE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS- _.:_._.......DAY OF-...�......__..-_._._-.__-___.-19_ ._ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_,................... ------. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS---_-------------------.------..._......_......_..__........-...__.-----.._..._..s... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND
DISCONNECT PLUG A
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
ND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E3
SIGNATURE SEEP.PIT(S)[:] CESSPOOLS
OF PERMITTEE---...__.-._-.-...-_,..:..... --
76A642A 663 7/33 ``.